Stage-Related Cost of Treatment of Bladder Cancer in Brazil.

Purpose: Bladder cancer is the ninth most frequent cancer worldwide with the twelfth highest incidence. However, its treatment has financial impacts that directly affect health burden. There is a scarcity of data about the costs related to healthcare in Brazil, especially in the public setting. As previously demonstrated, despite not being one of the most frequent cancers, bladder cancer appears to be one of the most expensive. The present study aimed to assess the costs related to the treatment of bladder cancer in the public setting in Brazil.

Patients And Methods: Retrospective data of patients treated for urothelial bladder carcinoma from 2019 to 2020 were retrieved at a single center. All charts were reviewed, with the assessment of clinical data, exams, surgical data, and post-procedure outcomes. The hospital finance department calculated the costs for outpatient evaluation, inpatient procedures, complementary exams, materials, drugs, and professionals' fees throughout all operations.

Results: A total of 107 patients with bladder cancer were analyzed, representing a total expenditure of BRL 5,671,042.70 and a mean cost of BRL 53,000.04 per patient (US$1.00 = BRL 5.60). Median costs were progressively higher for patients with stages I, II, III, and IV. Patients who underwent radical cystectomy (n = 14) had a median treatment cost of BRL 136,606.25 ± 96,059.08, during a mean follow-up of 9.2 months. Hospitalization costs represented 25% (range 20-43% according to the stage) of all expenditure. Medications and medical supplies represented 18% (16-23% according to the stage) of expenditure. Medical fees represented 31% of costs for stage I disease, but only 4% in stage II, III, and IV. Costs associated with emergency room visits were only observed in stage III and IV disease, representing 1% of all expenditure.

Conclusions: The management of bladder cancer resulted in a significant economic burden on our public health system. The costs associated with stage I bladder cancer were 4-12 times higher than those related to the treatment of other common malignancies at initial stages. Treatment was also expensive during the first months with more advanced stages.